Diabetics are prone to foot ulcerations due to both neurologic and vascular complications. Diabetic foot ulcers are the most common foot injuries leading to lower extremity amputation.
Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease.
A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications.
Proper foot hygiene, nail care and proper footwear is critical to lessen the risk of an injury that can lead to ulcer formation, therefore it is the health worker's duty to educate all diabetic patients on how they can protect their feet.
Diabetic foot ulcers are caused by neuropathic (nerve) and vascular (blood vessel) complications of the disease. Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg. This is known as peripheral neuropathy. Pressure from shoes, cuts, bruises, or any injury to the foot may go unnoticed. The loss of protective sensation stops the patient from being warned that the skin is being injured and may result in skin loss, blisters and ulcers.
Vascular disease is also a major problem in diabetes and especially affects very small blood vessels feeding the skin (microangiopathy). In this situation, it might be difficult for a doctor to find normal pulses in the feet because the arteries are unaffected. However other diabetic patients may also have narrowed arteries so that no pulse can be found in the feet (ischaemia). The lack of healthy blood flow may lead to ulceration. Wound healing is also impaired.
To help relieve foot pain diabetes foot cream can helps break down hardened, callused skin and eliminate cracks and fissures, lessening the chances of loss of feeling and making sure the feet are not dry.
